Expectativas e grau de satisfação da grávida e puérpera com o tipo de parto

A gravidez reflete uma aprendizagem experiencial e formativa, marcada por alterações físicas, cognitivas, comportamentais e afetivas. A sua experiência culmina no parto, um momento irreversível e marcante, geralmente diferente das expectativas e da forma como é antecipado e idealizado. Neste contexto, o presente estudo tem como principal objetivo avaliar as expectativas e o grau de satisfação da mulher com a experiência do parto, tendo também como intuito oferecer um contributo nesta área. Para este efeito, a uma amostra de 101 grávidas, utentes da consulta externa do Serviço de Obstetrícia e Ginecologia do Centro Hospitalar Cova da Beira, EPE, aplicaram-se dois tipos de questionários em momentos diferentes: o Questionário Sociodemográfico e Obstétrico, no pré-parto, e o Questionário de Experiência e Satisfação com o Parto, aplicado até às 72 horas após o mesmo. Os resultados gerais espelham uma antecipação do parto diferente das expectativas iniciais, uma experiência mista de características positivas e negativas, um relaxamento precário no momento do parto, uma satisfação pronunciada com a qualidade das condições e cuidados prestados e, um grau de satisfação com a dor não muito elevado, refletido por alguma insatisfação quando o acesso é negado à anestesia epidural. A experiência do parto está associada a diferentes parâmetros, no entanto reveste-se de uma satisfação geral mais positiva com o parto eutócico. Todos estes fatores estão intrinsecamente associados e são suscetíveis de influenciar a qualidade da experiência do parto, sendo neste sentido importante a reflexão para a construção de uma percepção mais real, humana e positiva da experiência do parto.Pregnancy reflects an experiential and formative learning, marked by physical, cognitive, behavioural and affective changes. This experience reaches its highest point at childbirth, an irreversible and remarkable moment, usually different from the expectations and from the way it is anticipated and imagined. In these circumstances, the main aim of this study is not only measure the expectations and women’s satisfaction degree with childbirth experience, but also present a contribution to this field of study. To this purpose, two types of questionnaires were applied, in different moments, to a sample of 101 pregnant women, users of the outpatient consultation of the Obstetrics and Gynaecology Services at Centro Hospitalar Cova da Beira, EPE: The Sociodemographic and Obstetrical questionnaire, applied in pre-childbirth, and The Experience and Satisfaction with Delivery Questionnaire, applied in postpartum, in a maximum period of 72 hours after delivery. The overall results reflect not only childbirth anticipation different from the initial expectations, a mixed experience of positive and negative characteristics, a precarious relaxation at childbirth, a prominent satisfaction with the conditions and care given but also a not very high degree of satisfaction with pain reflected by some dissatisfaction when the access is denied to epidural anaesthesia. The childbirth experience is associated with different parameters, but the more positive overall satisfaction is observed in normal or vaginal childbirth (eutocia). All these factors are intrinsically connected and are susceptible of influencing the childbirth experience quality, being this way important the reflection for the construction of a more realistic, human and positive perception of the childbirth experience

Prevalence of iron deficiency anemia and iron deficiency in a pediatric population with inflammatory bowel disease

OBJECTIVES: Iron deficiency is the most common cause of anemia in children with inflammatory bowel disease, although the real prevalence is unknown. Intravenous iron is suggested as the first line treatment. This study aims to determine the prevalence of iron deficiency anemia in children with inflammatory bowel disease followed in a Pediatric Gastroenterology Unit of a tertiary center and to evaluate this unit's experience with intravenous iron. MATERIALS AND METHODS: A retrospective cohort study was designed involving children with inflammatory bowel disease followed in that unit between January 2001 and April 2016. Laboratory results were collected at the moment of diagnosis, after one-year follow-up and prior each IV iron administration performed during the study period. Anemia was defined according to World Health Organization criteria and the iron deficiency was defined using recent guidelines. RESULTS: Were studied 69 patients 71% had CD and 29% UC. 50.7% were female. Mean patient age at diagnosis was 13.3 years (range 1--17 years). Prevalence of ID and IDA at diagnosis was 76.8% and 43.5%, respectively. After one year follow-up, those values decreased to 68.1% (p=.182) and 21.7% (p=.002), respectively. Hemoglobin significantly increased (p<.001). Intravenous iron was administered to 92.8% of patients. No adverse reactions were reported. CONCLUSIONS: Intravenous iron is the first line in the treatment of Iron deficiency anemia in Inflammatory Bowel disease and it is safe and effective. Persistent anemia and iron deficiency are common.info:eu-repo/semantics/publishedVersio

Revisão sistematizada da literatura e opinião de peritos

Objective: The 3E (Evidence, Expertise, Exchange) Initiative is a multinational effort of rheumatologists aimed at developing evidence-based recommendations addressing specific questions relevant to clinical practice. The objective of the Portuguese contribution for the 3E Initiative was to develop evidence-based recommendations on how to investigate, follow-up and treat undifferentiated peripheral inflammatory arthritis (UPIA) adapted to local reality and develop additional recommendations considered relevant in the national context. Methods: An international scientific committee from 17 countries selected a set of questions concerning the diagnosis and monitoring of UPIA using a Delphi procedure. Evidence-based answers to each question were sought by a systematic literature search, performed in Medline, Embase, the Cochrane Library and ACR/EULAR 2007-2009 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In a national meeting, a panel of 63 Portuguese rheumatologists used the evidence which was gathered to develop recommendations, and filled the gaps in the evidence with their expert opinion. Finally, national recommendations were formulated and agreement among the participants was assessed. Results: A total of 54754 references were identified, of which 267 were systematically reviewed. Thirteen national key recommendations about the investigation, follow-up and treatment of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to the established operational diagnosis of UPIA, eight recommendations were related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, serologies, autoantibodies, radiographs, magnetic resonance imaging and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity), one addressed monitoring of clinical disease activity in UPIA, one aimed to find an useful method/score to predict a definitive diagnosis and the last one was related to treatment. Conclusion: Portuguese evidence-based recommendations for the management of UPIA in everyday practice were developed. Their dissemination and implementation in daily clinical practice should help to improve practice uniformity and optimize the management of UPIA patients.publishersversionpublishe

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved